Hamelmann Eckard, Vogelberg Christian, Szefler Stanley J
a Klinik für Kinder- und Jugendmedizin, Kinderzentrum Bethel, Evangelisches Krankenhaus Bielefeld GmbH , Akademisches Lehrkrankenhaus der Universität Münster , Bielefeld , Germany.
b Department of Pulmonology and Allergy , University Hospital Carl Gustav Carus, Technical University of Dresden , Dresden , Germany.
Expert Opin Pharmacother. 2017 Feb;18(3):305-312. doi: 10.1080/14656566.2017.1285906. Epub 2017 Feb 1.
Asthma is a prevalent disease affecting millions of individuals. Despite receiving guideline therapy with inhaled corticosteroids (ICS) with or without a long-acting β-agonist (LABA), a proportion of patients remain symptomatic or have suboptimal lung function. There is therefore an unmet need for additional therapies to improve asthma control. The long-acting anticholinergic tiotropium, delivered via the Respimat inhaler, is approved for the treatment of asthma in the EU, the USA, and other countries. Phase III investigation in adults has demonstrated that tiotropium improves lung function and asthma control, with a safety profile comparable with that of placebo. Areas covered: Clinical trials in adolescent patients (aged 12-17 years) with moderate or severe symptomatic asthma have shown that tiotropium Respimat as add-on to ICS, with or without other maintenance therapies, is a well-tolerated and efficacious bronchodilator showing trends toward improved asthma control, similar to data in adult patients. Expert opinion: Tiotropium Respimat may be of benefit as add-on maintenance therapy to medium- or high-dose ICS with or without LABA; however, further data are needed to directly compare the efficacy of ICS plus tiotropium versus ICS plus LABA in adolescents with symptomatic asthma, and to establish the long-term effects on airway modeling.
哮喘是一种影响数百万人的常见疾病。尽管接受了吸入性糖皮质激素（ICS）联合或不联合长效β受体激动剂（LABA）的指南推荐治疗，但仍有一部分患者症状持续或肺功能未达最佳状态。因此，对于改善哮喘控制的额外治疗方法仍有未满足的需求。通过Respimat吸入器给药的长效抗胆碱能药物噻托溴铵，在欧盟、美国和其他国家已被批准用于治疗哮喘。针对成人的III期研究表明，噻托溴铵可改善肺功能和哮喘控制，其安全性与安慰剂相当。涵盖领域：对患有中度或重度症状性哮喘的青少年患者（12至17岁）进行的临床试验表明，将噻托溴铵Respimat作为ICS的附加治疗，无论是否联合其他维持治疗，都是一种耐受性良好且有效的支气管扩张剂，显示出哮喘控制改善的趋势，类似于成人患者的数据。专家意见：噻托溴铵Respimat作为中高剂量ICS联合或不联合LABA的附加维持治疗可能有益；然而，需要进一步的数据来直接比较ICS加噻托溴铵与ICS加LABA在有症状的青少年哮喘患者中的疗效，并确定其对气道重塑的长期影响。
